<?php


$operators = array();
$agencies = array();
$taxonomies = array();
$unreachable = array();
$time = array();
$treated = array();
$contacted = array();
$assistance = array();


    $result = null;
    mysql_connect ("localhost", "root", "") or die ('Error: ' . mysql_error());
    mysql_select_db("QA");

     //load operators
     $i_count = 1;
     $result = mysql_query("select Staff_Operator from Caller where length(trim(Staff_Operator))>0 group by Staff_Operator");
     while ($row = mysql_fetch_array($result)){
         $operators[$i_count++] = $row['Staff_Operator'];
         //echo "ref#: ".$i_count.";agency:".$row['Staff_Operator']."<BR>";
     }     


     //load agencies
     $result = mysql_query("Select Agency_Description, Reference_Number From Agencies");
     while ($row = mysql_fetch_array($result)){
         $agencies[$row['Reference_Number']] = $row['Agency_Description'];
         //echo "ref#: ".$row['Reference_Number'].";agency:".$row['Agency_Description']."<BR>";
     }
     //ksort($agencies);
     //echo count($agencies)." agencies loaded<BR>";



     //load taxonomies
     $result = mysql_query("Select Taxonomy_Description, Reference_Number From Taxonomies");
     while ($row = mysql_fetch_array($result)){
         $taxonomies[$row['Reference_Number']] = $row['Taxonomy_Description'];
         //echo "ref#: ".$row['Reference_Number'].";taxonomy:".$row['Taxonomy_Description']."<BR>";
     }
     //echo count($taxonomies)." taxonomies loaded<BR>";



     //load unreachable
     $result = mysql_query("Select Reason_Description, Reference_Number From Unreachable_Reasons");
     while ($row = mysql_fetch_array($result)){
         $unreachable[$row['Reference_Number']] = $row['Reason_Description'];
         //echo "ref#: ".$row['Reference_Number'].";reason:".$row['Reason_Description']."<BR>";
     }
     //echo count($unreachable)." unreachable loaded<BR>";



     //load time
     $result = mysql_query("Select Time_Description, Reference_Number From Time");
     while ($row = mysql_fetch_array($result)){
         $time[$row['Reference_Number']] = $row['Time_Description'];
       //echo "ref#: ".$row['Reference_Number'].";time:".$row['Time_Description']."<BR>";
     }
     //echo count($time)." time loaded<BR>";


     //load treated
     $result = mysql_query("Select Treated_Description, Reference_Number From Treated");
     while ($row = mysql_fetch_array($result)){
        $treated[$row['Reference_Number']] = $row['Treated_Description'];
        //echo "ref#: ".$row['Reference_Number'].";treated:".$row['Treated_Description']."<BR>";
     }
     //echo count($treated)." treated loaded<BR>";


     //load contacted
     $result = mysql_query("Select Contacted_Description, Reference_Number From Contacted");
     while ($row = mysql_fetch_array($result)){
        $contacted[$row['Reference_Number']] = $row['Contacted_Description'];
        //echo "ref#: ".$row['Reference_Number'].";contacted:".$row['Contacted_Description']."<BR>";
     }
     //echo count($contacted)." contacted loaded<BR>";



     //load assistance
     $result = mysql_query("Select Assistance_Description, Reference_Number From Assistance");
     while ($row = mysql_fetch_array($result)){
        $assistance[$row['Reference_Number']] = $row['Assistance_Description'];
        //echo "ref#: ".$row['Reference_Number'].";assistance:".$row['Assistance_Description']."<BR>";
     }
     //echo count($assistance)." assistance loaded<BR>";



     //load refer
     $result = mysql_query("Select Refer_Description, Reference_Number From Refer");
     while ($row = mysql_fetch_array($result)){
        $refer[$row['Reference_Number']] = $row['Refer_Description'];
        //echo "ref#: ".$row['Reference_Number'].";refer:".$row['Refer_Description']."<BR>";
     }
     //echo count($refer)." refer loaded<BR>";



?>

<html>
<HEAD>


    <style type="text/css">
	.suggestion_list
	{
	background: white;
	border: 1px solid;
	padding: 4px;
	}
	
	.suggestion_list ul
	{
	padding: 0;
	margin: 0;
	list-style-type: none;
	}
	
	.suggestion_list a
	{
	text-decoration: none;
	color: navy;
	}
	
	.suggestion_list .selected
	{
	background: navy;
	color: white;
	}
	
	.suggestion_list .selected a
	{
	color: white;
	}

	#autosuggest
	{
	display: none;
	}
    </style>


<script type="text/javascript" src="datepickercontrol/datepickercontrol.js"></script>
<script type="text/javascript" src="autosuggest_0.1/autosuggest.js"></script>
<script language="javascript"> 
<!--
var agencies = new Array();
var agencykeys = new Array();
var operators = new Array();
<?php
     foreach($agencies as $key => $value){
          echo "agencies[".$key."]=\"".$value."\";\n";
     }

     foreach($agencies as $key => $value){
          echo "agencykeys[\"".$value."\"]=".$key.";\n";
     }
     foreach($operators as $key => $value){
	  echo "operators[".$key."]=\"".$value."\";\n";
     }
?>

 
var state_unreachable = 'none'; 
var state_needs = 'none'; 
var state_agencies = 'none'; 
var state_agency2 = 'none'; 
var state_211QA = 'none'; 

function myReset(myform){
	myform.reset();
	if(state_unreachable == 'block'){showhide_unreachable('Unreachable');} 
	if(state_needs == 'block'){showhide_needs('Need');} 
	if(state_agencies == 'block'){showhide_agencies('Agency')}
	if(state_agency2 == 'block'){showhide_agency2('agency2');} 
	if(state_211QA =='block'){showhide_211QA('qafeedback');}
}

function showhide_unreachable(layer_ref) { 

if (state_unreachable == 'block') { 
state_unreachable = 'none'; 
} 
else { 
state_unreachable = 'block'; 
} 
if (document.all) { //IS IE 4 or 5 (or 6 beta) 
eval( "document.all." + layer_ref + ".style.display = state_unreachable"); 
} 
if (document.layers) { //IS NETSCAPE 4 or below 
document.layers[layer_ref].display = state_unreachable; 
} 
if (document.getElementById &&!document.all) { 
hza = document.getElementById(layer_ref); 
hza.style.display = state_unreachable; 
} 
} 


function showhide_needs(layer_ref) { 

if (state_needs == 'block') { 
state_needs = 'none'; 
} 
else { 
state_needs = 'block'; 
} 
if (document.all) { //IS IE 4 or 5 (or 6 beta) 
eval( "document.all." + layer_ref + ".style.display = state_needs"); 
} 
if (document.layers) { //IS NETSCAPE 4 or below 
document.layers[layer_ref].display = state_needs; 
} 
if (document.getElementById &&!document.all) { 
hza = document.getElementById(layer_ref); 
hza.style.display = state_needs; 
} 
}


function showhide_agencies(layer_ref) { 

if (state_agencies == 'block') { 
state_agencies = 'none'; 
} 
else { 
state_agencies = 'block'; 
} 
if (document.all) { //IS IE 4 or 5 (or 6 beta) 
eval( "document.all." + layer_ref + ".style.display = state_agencies"); 
} 
if (document.layers) { //IS NETSCAPE 4 or below 
document.layers[layer_ref].display = state_agencies; 
} 
if (document.getElementById &&!document.all) { 
hza = document.getElementById(layer_ref); 
hza.style.display = state_agencies; 
} 
}


function showhide_agency2(layer_ref) { 
if (state_agency2 == 'block') { 
state_agency2 = 'none'; 
} 
else { 
state_agency2 = 'block'; 
} 
if (document.all) { //IS IE 4 or 5 (or 6 beta) 
eval( "document.all." + layer_ref + ".style.display = state_agency2"); 
} 
if (document.layers) { //IS NETSCAPE 4 or below 
document.layers[layer_ref].display = state_agency2; 
} 
if (document.getElementById &&!document.all) { 
hza = document.getElementById(layer_ref); 
hza.style.display = state_agency2; 
} 
}



function showhide_211QA(layer_ref) { 

if (state_211QA == 'block') { 
state_211QA = 'none'; 
} 
else { 
state_211QA = 'block'; 
} 
if (document.all) { //IS IE 4 or 5 (or 6 beta) 
eval( "document.all." + layer_ref + ".style.display = state_211QA"); 
} 
if (document.layers) { //IS NETSCAPE 4 or below 
document.layers[layer_ref].display = state_211QA; 
} 
if (document.getElementById &&!document.all) { 
hza = document.getElementById(layer_ref); 
hza.style.display = state_211QA; 
} 
}





function textCounter( field, countfield, maxlimit ) {
  if ( field.value.length > maxlimit )
  {
    field.value = field.value.substring( 0, maxlimit );
    alert( 'Textarea value can only be 255 characters in length.' );
    return false;
  }
  else
  {
    countfield.value = maxlimit - field.value.length;
  }
}




//--> 
</script> 


<link type="text/css" rel="stylesheet" href="datepickercontrol/datepickercontrol.css"> 

</HEAD>
<body><BR><BR>
<div id="autosuggest"><ul></ul></div>

<DIV style="font-family:Arial;width=90%">

<TABLE border=0 padding=0 width=100%><TR width=100%><TD align=left><U><B>Call QA Record</B></U></TD><TD align=center><A HREF="notices.php" target=_Top>Notices</A></TD><TD align=right><A HREF="procedures.php" target=_Top>Procedures</A></TD></TR></TABLE>
<BR>
<form name="input_form" id="input_form" action="save.php" method="post">
<input type="hidden" id="record_type_value" value="">
<DIV id="Client" style="border:solid thin black">
<U>Complete this section for every record in Alliance that you work</U><BR><BR>
<TABLE border=0>
<TR><TD>
Alliance Client Number: <input type="text" size=10 maxlength=9 name="client_number" /><BR>
</TD><TD>
<input type="hidden" name="staff_operator" id="staff_operator"/>
211 Staff Operator: <input type="text" size=50 maxlength=255 id="staff_operator_picker" name="staff_operator_picker" onblur="javascript:staff_operator.value = staff_operator_picker.value;">
	<script language="Javascript">
		new AutoSuggest(document.getElementById('staff_operator_picker'),operators);
	</script>
</input>
</TD></TR>
</TABLE>
<BR>
<input type="hidden" id="DPC_TODAY_TEXT" value="today">
<input type="hidden" id="DPC_BUTTON_TITLE" value="Open calendar...">
<input type="hidden" id="DPC_MONTH_NAMES" value="['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December']">
<input type="hidden" id="DPC_DAY_NAMES" value="['Sun', 'Mon', 'Tue', 'Wed', 'Thu', 'Fri', 'Sat']">
<input type="hidden" id="DPC_DEFAULT_FORMAT" value="YYYY-MM-DD">
<input type="hidden" id="DPC_SUBMIT_FORMAT" value="YYYY-MM-DD">
Original date of call: <input type="text" name="call_date" id="calldate" size="12" style="border-width:1px;" datepicker="true"><BR>
</DIV>

</DIV>
<BR>
<DIV style="font-family:Arial;width=90%">

<fieldset style="background-color:#BBBBBB">
<legend>
<DIV style="color:#000000">
<U>Select <I>One</I> of the following Call Types</U> - (Click call type below to Expand/Collapse)
<DIV>
</legend>


<BR>
<p>
<a name="Unreachable_Name" style="text-decoration:underline;color:blue;" onclick="showhide_unreachable('Unreachable');"><DIV style="cursor: pointer; cursor: hand;">Unreachable</DIV></A>
</p> 
<div id="Unreachable" style="display:none;background-color: #FFFFFF;">
<fieldset>
<legend>
Unreachable Client Information
</legend>
<input type="radio" name="record_type" id="record_type" value="unreachable"  onclick="javascript:document.input_form.record_type_value.value='unreachable';document.input_form.need_met.value=0;"/> SELECT IF THIS IS AN UNREACHABLE RECORD YOU ARE ENTERING<BR>
Reason Caller Unreachable: <BR>
<SELECT name="unreachable" SIZE=<?php echo count($unreachable); ?>>
<?php
     $isfirst=0;     
     foreach($unreachable as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT>
<BR>
Other: &nbsp&nbsp&nbsp&nbsp<input type="text" name="unreachable_other"/>
<BR>
Taxonomy Call Attempted For:<BR>
<SELECT name="unreachable_taxonomy" SIZE=10>
<?php
     $isfirst =0;
     foreach($taxonomies as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT>
</fieldset>
</DIV>


<BR>
<p>
<a name="Need_Name" style="text-decoration:underline;color:blue;" onclick="showhide_needs('Need');"><DIV style="cursor: pointer; cursor: hand;">Doesn't Remember the Agencies</DIV></A>
</p> 
<div id="Need" style="display: none;background-color: #FFFFFF;">
<fieldset>
<legend>
Needs Met or Unmet Information - Use if the caller doesn't remember the agency or agencies referred
</legend>
<input type="radio" name="record_type" id="record_type" value="need_met" onclick="javascript:document.input_form.record_type_value.value='need_met';document.input_form.need_met.value=1;"/> SELECT IF THIS IS A NEEDS RECORD YOU ARE ENTERING<BR>
<input type="hidden" name="need_met" value=0/>
Was their need met?<BR>
<select name="need_was_met" Size=1>
     <Option value="0">No</OPTION>
     <Option value="1">Yes</OPTION>
</Select><BR>
Needs Taxonomy: <BR>
<SELECT name="need_taxonomy" SIZE=10>
<?php
     $isfirst=0;
     foreach($taxonomies as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }

     }
?>
</SELECT>
</fieldset>
</DIV>


<BR>
<p>
<a name="Agency_Name" style="text-decoration:underline;color:blue;" onclick="showhide_agencies('Agency');"><DIV style="cursor: pointer; cursor: hand;"> Remembers the Agencies </DIV></A>
</p> 
<div id="Agency" style="display: none;background-color: #FFFFFF;">
<fieldset>
<legend>
<DIV style="color:#000000">First Agency Experience Detail</DIV>
</legend>
<input type="radio" name="record_type" id="record_type" value="agency_1" onclick="javascript:document.input_form.record_type_value.value='agency_1';document.input_form.need_met.value=0;" /> SELECT IF THIS IS AN SINGLE AGENCY RECORD YOU ARE ENTERING<BR>
<a name="Agency2_Name" style="text-decoration:underline;color:blue;" onclick="showhide_agency2('agency2');"><DIV style="cursor: pointer; cursor: hand;">Click Here to evaluate a second agency (Click here to Expand/Collapse)</DIV></A>
<DIV id="agency2" style="display: none;border:solid thin black">


<fieldset>
<legend><DIV style="color:#000000">Second Agency Experience Detail (optional)</DIV>
</legend>
<input type="radio" name="record_type" id="record_type" value="agency_2" onclick="javascript:document.input_form.record_type_value.value='agency_2';document.input_form.need_met.value=0;" /> SELECT IF THIS IF YOU ARE ENTERING A SECOND AGENCY RECORD<BR>
<TABLE boarder=0px>
<TR>
<TD width="50%">
Taxonomy: <BR>
<SELECT name="agency_taxonomy_2" SIZE=10 style="width:350px" width="350px">
<?php
     $isfirst=0;
     foreach($taxonomies as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }

     }
?>
</SELECT><BR>
</TD>
<TD width="50%" valign="top">
Ageny Name: <BR>

<input type="hidden" id="agency_name_2" name="agency_name_2" value="0"/>
<input type="text" size="50" maxlength="255" name="agencypicker2" id="agencypicker2" onblur="javascript:agency_name_2.value = agencykeys[agencypicker2.value];">
	<script language="Javascript">
		new AutoSuggest(document.getElementById('agencypicker2'),agencies);
	</script>
</input>



<BR>

</TD>
</TR>
</TABLE>


<TABLE border=0px>
<TR>
<TD colspan=2 valign="top">

Contacted:<BR>
(Did the 211 client make contact with the referred agency?)<BR>
</TD></TR>
<TR>
<TD valign="top">
<?php
     $other_number=0;
     foreach($contacted as $key => $value){
          if($value=="Other"){
              $other_number=$key;
	  }
     }
?>
<SELECT name="agency_contacted_2" SIZE=<?php echo count($contacted); ?> onBlur="javascript:if((agency_contacted_2.value==<?php echo $other_number ?>)&&(contactedother2.value.length==0)){alert('Other selected please enter more information in the Other field.');contactedother2.focus();};">
<?php
     $isfirst=0;
     foreach($contacted as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT>
</TD>
<TD valign="bottom" align="left">

Other: <BR>

<input type="text" size="35" maxlength="255" name="contactedother2" id="contactedother2" onBlur="javascript:if((agency_contacted_2.value==<?php echo $other_number ?>)&&(contactedother2.value.length==0)){alert('Other selected please enter more information in the Other field.');contactedother2.focus();};"/>

<BR>
</TD>
</TR>
</TABLE>

Time until contact:<BR>
<SELECT name="agency_contacted_time_2" SIZE=<?php echo count($time); ?> >
<?php
     $isfirst=0;
     foreach($time as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT><BR>
Assistance: <BR>
<?php
     $assistance_number=0;
     $assistance_explain = array();
     foreach($assistance as $key => $value){
          if($value=="Other"){
 		$assistance_number=$key;
	  }
	  if( strpos($value, "Other") != false ){
		push($assistance_explain, $key);
	  }
     }
?>

<SELECT name="agency_assistance_2" id="agency_assistance_2" SIZE=<?php echo count($assistance); ?>  onBlur="javascript:if((this.id=='agency_assistance_2')&&(agency_assistance_2.value==<?php echo $assistance_number ?>)&&(agency_assistance_explanation_2.value.length==0)){alert('Other selected please enter more information in the Explanation field.');agency_assistance_explanation_2.focus();};">

<?php
     $isfirst=0;
     foreach($assistance as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"$key\">$value</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
    }     }
?>
</SELECT><BR>
Assistance Explanation: &nbsp&nbsp&nbsp&nbsp<input type="text" name="agency_assistance_explanation_2"  id="agency_assistance_explanation_2" maxlength=255 size=100 onBlur="javascript:if((this.id=='agency_assistance_explanation_2')&&(agency_assistance_2.value==<?php echo $assistance_number ?>)&&(agency_assistance_explanation_2.value.length==0)){alert('Other selected please enter more information in the Explanation field.');agency_assistance_explanation_2.focus();};" /><BR>
Treated: <BR>
<SELECT name="agency_treated_2" SIZE=<?php echo count($treated); ?>>
<?php
     $isfirst=0;
     foreach($treated as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT><BR>
</fieldset>

</DIV>

<BR>
<TABLE boarder=0px>
<TR>
<TD width="50%">

Taxonomy: <BR>
<SELECT name="agency_taxonomy_1" SIZE=10 style="width:350px" width="350px">
<?php
     $isfirst=0;
     foreach($taxonomies as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT><BR>

</TD>
<TD width="50%" valign="top">
Ageny Name: <BR>


<input type="hidden" id="agency_name_1" name="agency_name_1" value="0"/>
<input type="text" size="35" maxlength="255" name="agencypicker1" id="agencypicker1" style="layer:top" onblur="javascript:agency_name_1.value = agencykeys[agencypicker1.value];">
	<script language="Javascript">
		new AutoSuggest(document.getElementById('agencypicker1'),agencies);
	</script>
</input>


<BR>

</TD>
</TR>
</TABLE>



<TABLE border=0px>
<TR>
<TD colspan=2 valign="top">

Contacted:<BR>
(Did the 211 client make contact with the referred agency?)<BR>
</TD></TR>
<TR>
<TD valign="top">
<SELECT name="agency_contacted_1" id="agency_contacted_1" SIZE=<?php echo count($contacted); ?> onBlur="javascript:if((this.id=='agency_contacted_1')&&(agency_contacted_1.value==<?php echo $other_number ?>)&&(contactedother1.value.length==0)){alert('Other selected please enter more information in the Other field.');contactedother1.focus();};" >
<?php
     $isfirst = 0;
     foreach($contacted as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT>
</TD>
<TD valign="bottom" align="left">

Other: <BR>

<input type="text" size="35" maxlength="255" name="contactedother1" id="contactedother1" onBlur="javascript:if((agency_contacted_1.value==<?php echo $other_number ?>)&&(contactedother1.value.length==0)&&(this.id=='contactedother1'){alert('Other selected please enter more information in the Other field.');contactedother1.focus();};" />

<BR>
</TD>
</TR>
</TABLE>




<BR>
Time until contact:<BR>
<SELECT name="agency_contacted_time_1" SIZE=<?php echo count($time); ?>>
<?php
     $isfirst=0;
     foreach($time as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT><BR>
Assistance: <BR>
<SELECT name="agency_assistance_1" SIZE=<?php echo count($assistance); ?> onBlur="javascript:if((agency_assistance_1.value==<?php echo $assistance_number ?>)&&(agency_assistance_explanation_1.value.length==0)){alert('Other selected please enter more information in the Explanation field.');agency_assistance_explanation_1.focus();};">
<?php
     $isfirst=0; 
     foreach($assistance as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT><BR>
Assistance Explanation: &nbsp&nbsp&nbsp&nbsp<input type="text" name="agency_assistance_explanation_1" maxlength=255 size=100 onBlur="javascript:if((agency_assistance_1.value==<?php echo $assistance_number ?>)&&(agency_assistance_explanation_1.value.length==0)){alert('Other selected please enter more information in the Explanation field.');agency_assistance_explanation_1.focus();};" /><BR>
Treated: <BR>
<SELECT name="agency_treated_1" SIZE=<?php echo count($treated); ?>>
<?php
     $isfirst=0;
     foreach($treated as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</SELECT><BR>
</fieldset>

<BR>


</fieldset>
</DIV>

</DIV>
<BR>
<DIV style="font-family:Arial;width=90%">

<fieldset>
<legend>
<a name="211QA" style="text-decoration:underline;color:blue;" onclick="showhide_211QA('qafeedback')"><DIV style="cursor: pointer; cursor: hand;">211 Feedback - Complete with every client (Click here to Expand/Collapse)</DIV></A>
</legend>
<BR>
<DIV id="qafeedback" style="display: none;border:solid thin black">
<BR>
Did our staff provide the caller with the appropriate referrals and information according to their need? <BR>
<select name="appropriate" Size=1>
     <Option value="0" selected>No</OPTION>
     <Option value="1">Yes</OPTION>
</Select><BR>
Would the caller recommend 211 to family and friends? <BR>
<select name="refer" Size=1>
<?php
     $isfirst=0;
     foreach($refer as $key => $value){
          if($isfirst==0){
              $isfirst++;
              echo "<Option selected Value=\"".$key."\">".$value."</OPTION>";
          }else{
              echo "<Option Value=\"".$key."\">".$value."</OPTION>";
          }
     }
?>
</Select><BR>
Comments: <BR>
<TEXTAREA
	NAME="comments"
	ROWS="5"
	COLS="100"
	onkeypress="textCounter(this,document.input_form.counter,255);">
</TEXTAREA>
<br>
<input
	type="text"
	name="counter"
	maxlength="3"
	size="3"
	value="255"
	READONLY DISABLED> characters remaining in the comment
<BR>
</DIV>
<BR>
</fieldset>
<input type="button" value="Clear Form and Start Over" onClick="javascript:myReset(document.input_form);" />
<input type="submit" value="Submit" />
</form>
<BR>
<A href="http://211qa.uservoice.com/pages/34599-general?lang=en&utm_campaign=Widgets&utm_content=tab-widget&utm_medium=widget&utm_source=211qa.uservoice.com" target="_Top">click here to visit the feedback forum where you can provide bug reports, enhancement requests and support questions!</A>
</DIV>
</body>
</html>